It’s a Friday morning in Ho Chi Minh City and the meeting room at Family Medical Practice’s District 2 clinic is filling with people who have come to listen to psychiatrist Dr Miguel de Seixas’ free seminar on what he sees as the city’s worrying relationship with alcohol.

Present in the room is an even-mix of male and female attendees of various ages; some are Vietnamese, but most are foreign.

From Portugal and a member of the Royal College of Psychiatrists in the UK, Dr de Seixas has extensive experience treating people diagnosed with mental health conditions.

His experience includes time heading up a clinic in London treating pregnant mothers with drug addictions, an experience he later recalls with an anecdote about how anything containing alcohol in the clinic had to be confiscated, including alcohol-based hand wash.

“It’s an extreme example, but that’s how desperate alcoholics can get,” says the doctor.

Dr Miguel de Seixas.Photo by Matthew Cowan

Dr de Seixas’ seminar today has been motivated by what he has observed in the time he has been living in Ho Chi Minh City.

He has noticed that alcohol is ever-present here in both local and foreign communities, and that the culture surrounding its consumption is unlike anything he has witnessed before.

It is obvious that people drink a lot, something that tells him many drinkers here don’t appear to know how much is too much and when to stop.

“It’s the most commonly used recreational substance around the world,” Dr de Seixas says of alcohol, after showing a short video highlighting the influence it can have over relationships, parenting, sex lives, work and health in general, “but alcoholism is a complicated problem because there just isn’t one cause.”

What is certain, however, is that people drink for many different reasons, that is nothing new.

Studies have shown that genes play a role, so much so, that people with first-degree relatives (parents, siblings, sons/daughters) with a known alcohol problem are seven-times more likely to have alcohol problems than the general population.

Correlations have also been found in twins and in adoption studies.

Children of alcoholic parents adopted into non-alcoholic families are more likely to become alcoholics compared to the general population.

Yet, the blame for becoming alcoholic cannot simply be attributed to being in the wrong line when the genes associated with alcoholism were handed out, as Dr de Seixas goes on to explain.

“There are a wide variety of environmental factors at play. The prevalence of drinking in a society changes from culture to culture, which is largely due to these environmental factors. When I first went to England, for instance, I found it difficult to adapt to the drinking culture there, it was very confusing for me.”

Now in Vietnam, Dr de Seixas is faced with a completely different drinking culture again.

Vietnam has a very close relationship with alcohol. It is listed among the world’s top ten nations for beer consumption and it has been widely reported that in 2016, just over 3.5 billion litres of beer was produced here, with projections putting production at 4.1 billion litres by 2020.

That means on average, the Vietnamese consume 42 litres of beer per person every year.

To put that into perspective, every man, woman and child in Vietnam would have to drink the equivalent volume of just over two 19 litre (5 gallons) water bottles, the size of the ones typically used in Vietnamese homes to store drinking water.

But it is at the expatriate population in Ho Chi Minh City that Dr de Seixas is targeting his message in his seminar today.

Most of the people he sees and treats for alcohol-related issues are from the expat community.

In the very short time he has been here, he has noticed that his patients can be categorised with one, sometimes two, traits that are strongly associated with alcoholism.

They are people with marked neuroticism or openness to new experiences, both of which are elements of the Big 5 personality traits in psychology studies. People with neuroticism, for example, are more likely to experience anxiety, anger, fear, frustration, jealousy, loneliness and depression, among other feelings.

“People that leave their countries, leave their families and friends and come to a different place like Ho Chi Minh City, are probably more open to experience, more open to taking risks. Not everyone leaves their relationships and their lives behind to settle into a completely new place,” says Dr de Seixas.

“I see a group of people here who have strong neuroticism as a personality trait,” continues Dr de Seixas. “I’m talking about hard-working, conscientious, perfectionists who have advanced in their careers because these traits have been an advantage to them. But in the context of dealing with pressure, it puts them more at risk of not coping, they become stressed as a result, feel anxious and wind up drinking to relax. It becomes a means to an end, rather than a way of socialising. They drink for a purpose because it makes them feel better or less bad.”

Someone who matches Dr de Seixas profile is 35 year-old expat Tim* who has been living in Ho Chi Minh City for over a decade.

Tim describes himself as curious intellectually and socially, as someone who reads a lot and loves socialising, but is stubborn and determined with things work-related.

“I get obsessed with getting the details right with work and I’ll pursue the solution to a problem for as long as it takes,” he says during our meeting at a downtown Ho Chi Minh City cafe.

“I’m someone who pushes the line between what’s acceptable in life, and what’s not — I can be wild. However, there are times when I take a let’s-wait-and-see approach to things. I don’t really need a plan, just a starting point. And, I can be very sensitive to other people’s feelings.”

Tim says his relationship with alcohol started as a child stealing sips of beer from adults at gatherings, then progressing to underage drinking at parties and in the park with friends as a teenager.

When he moved to Ho Chi Minh City to work, it triggered a five-year bender that he describes at first as “pretty heavy” but goes on to reveal later he would drink four-to-five nights per week, consuming 15 drinks a night at a minimum, with one “massive night a week thrown in till 3am, 4am or 5am.”

“The main reasons why I drank more when I came to Ho Chi Minh City to live were because of opportunity, options, and fun. It’s more affordable here for a start. I guess the systems in place in my country would have slowed me down — like the refusal of serving alcohol to anyone intoxicated, and earlier closing times. The price would’ve definitely been a factor in curtailing my drinking, too.”

During his seminar, Dr de Seixas discusses the significant environmental factors at play in cities like Ho Chi Minh City that encourage drinking.

“There are cues and prompts [triggers that tempt people to have a drink]. It’s very difficult in this city to walk any meaningful length without coming to a bar. There’s a lot of exposure to drinking.”

In Tim’s case above, he identifies one of the reasons why he drank more here than in his home country with what Dr de Seixas refers to as “friction”.

Friction, whether it comes in the form of price, closing hours or family responsibilities among other factors, works in changing people’s behaviour.

There is less friction here towards alcohol consumption within the expat community, that is, there are fewer barriers to having a big night out. In fact, alcohol underpins socialisation in Ho Chi Minh City, something that Tim can relate to well.

“Almost all of the expat community lifestyle is centred around bars. If you want to see your friends, you have to go to a bar.”

But Tim is quick to point out that he’s not blaming anyone but himself for the lifestyle he once led.

“Perhaps the most important reason for the path I went down was that it’s a lot of fun. I genuinely had the time of my life during those years. Lots of bars, lots of drinks, and they really know how to make someone feel special and welcome. Can you imagine walking into places where you’re treated like a superstar by a ton of gorgeous, attractive, fun, and often very interesting women? It’s very hard to give up.”

Meanwhile, with so much drinking and partying, there is a big downside.

“It often starts out as simply socialising,” explains Dr de Seixas, of the downward spiral into alcohol dependency and abuse.

“There’s a “friendship” with alcohol, then you drink a little more, and suddenly you’re having problems. Your support network might not be here, your friends might be on another continent in a different time zone.

"To meet up with new friends here, you typically go to a bar, but if you don’t want to go to a bar, it means you’re less likely to meet up with those friends and then you’re on your own.

"Before you know it, you’re going along this spectrum to the point where you need alcohol, you begin to find ways to prioritise alcohol over your work or your private life.”

With Tim, the comparisons are striking with what Dr de Seixas says.

“The side-effects of drinking like I did is much like playing sport. You get match fit and learn to adjust to it. In a way, the more you do it, the more you want to do it, because you feel a lot better after you’ve had a few beers.”

Looking back, Tim says he didn’t have time for the things in life that he finds interesting and satisfying, although he still managed to complete further studies and become a father in that time.

But there is still a sense of underachievement he feels in both his professional and personal lives.

“For me it’s hard to tell how I was different because a lot of traumatic things happened during that time as well, so I’m not sure if it was the trauma or the drinking, maybe it was the alcohol tricking me into blaming something else, but I definitely wasn’t able to handle little problems as well, they became bigger than they should’ve been. I was more emotionally unstable, over-reactive and slightly paranoid.”

Ironically, perhaps the event that saved Tim from continuing down the path he was headed, was a break up with his girlfriend. She had worked in a bar, so when they broke up, he stopped going to see her while she was at work — “in a way, it broke the spell,” says Tim.

“I had also put on a lot of weight and wasn’t happy with how I looked, and I thought, if I ever wanted to have a girlfriend again, I was going to have to do something. I guess I was at a crossroads.

"I’d had a lot of stuff go bad for me and it was either give in to it all, which I think people would’ve understood, or start making myself stronger and better mentally, emotionally and physically.”

Towards the end of the seminar, Dr de Seixas opens up the floor for questions and comments. People ask what signs they should look out for that indicate alcohol abuse, and whether there is a definitive description of an alcoholic.

But perhaps the question that is on everyone’s mind, is one about the resources available in Ho Chi Minh City for withdrawal from alcohol.

There are few places in Asia let alone Vietnam that can support people through detox and rehabilitation. Dr de Seixas says that Family Medical Practice has managed one case in the past when a person was admitted for severe alcohol use, after which, a symptom-triggered detox was initiated.

However, programs like this can only work in special circumstances. As such, Family Medical Practice does not currently have the ability to perform classic inpatient detoxes as a matter of routine.

“Vietnam is a difficult country to live in if you have a health problem,” he answers in response to a question on what people thinking about relocating to Vietnam should consider before making the commitment.

"It may not be the right country for you.”

At risk of sounding cliche, Tim’s advice for men already in Vietnam or for those contemplating a move here, and who may already have a close relationship with alcohol, is this — give yourself a budget and stick to it, have fun, but don’t be out all the time.

One way of achieving this is by continuing to do the things you like, for example, exercising, playing music, reading.

“Remember, if you love going to bars, everything and everyone will most likely be there next week. You won’t miss out on much by having a few nights off. Also, at the end of the day, for a number of very understandable reasons, the girls in those bars are there to sell you drinks and get your money. I don’t mean this in a judgemental way — it is what it is.”